Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline

J Clin Oncol. 2014 Jun 20;32(18):1941-67. doi: 10.1200/JCO.2013.54.0914. Epub 2014 Apr 14.

Abstract

Purpose: To provide evidence-based guidance on the optimum prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathies (CIPN) in adult cancer survivors.

Methods: A systematic literature search identified relevant, randomized controlled trials (RCTs) for the treatment of CIPN. Primary outcomes included incidence and severity of neuropathy as measured by neurophysiologic changes, patient-reported outcomes, and quality of life.

Results: A total of 48 RCTs met eligibility criteria and comprise the evidentiary basis for the recommendations. Trials tended to be small and heterogeneous, many with insufficient sample sizes to detect clinically important differences in outcomes. Primary outcomes varied across the trials, and in most cases, studies were not directly comparable because of different outcomes, measurements, and instruments used at different time points. The strength of the recommendations is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms.

Recommendations: On the basis of the paucity of high-quality, consistent evidence, there are no agents recommended for the prevention of CIPN. With regard to the treatment of existing CIPN, the best available data support a moderate recommendation for treatment with duloxetine. Although the CIPN trials are inconclusive regarding tricyclic antidepressants (such as nortriptyline), gabapentin, and a compounded topical gel containing baclofen, amitriptyline HCL, and ketamine, these agents may be offered on the basis of data supporting their utility in other neuropathic pain conditions given the limited other CIPN treatment options. Further research on these agents is warranted.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Adult
  • Amines / therapeutic use
  • Amitriptyline / administration & dosage
  • Analgesics / therapeutic use*
  • Anticonvulsants / therapeutic use
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Baclofen / administration & dosage
  • Comorbidity
  • Cyclohexanecarboxylic Acids / therapeutic use
  • Drug Therapy, Combination
  • Duloxetine Hydrochloride
  • Evidence-Based Medicine
  • Gabapentin
  • Gels
  • Humans
  • Incidence
  • Ketamine / administration & dosage
  • Neoplasms / drug therapy*
  • Neuralgia / drug therapy
  • Neuralgia / etiology
  • Neuralgia / prevention & control*
  • Peripheral Nervous System Diseases / chemically induced*
  • Peripheral Nervous System Diseases / complications
  • Peripheral Nervous System Diseases / drug therapy
  • Peripheral Nervous System Diseases / physiopathology
  • Peripheral Nervous System Diseases / prevention & control*
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Survivors*
  • Thiophenes / therapeutic use*
  • Treatment Outcome
  • United States
  • gamma-Aminobutyric Acid / therapeutic use

Substances

  • Amines
  • Analgesics
  • Anticonvulsants
  • Antidepressive Agents, Tricyclic
  • Antineoplastic Agents
  • Cyclohexanecarboxylic Acids
  • Gels
  • Thiophenes
  • Amitriptyline
  • gamma-Aminobutyric Acid
  • Ketamine
  • Gabapentin
  • Duloxetine Hydrochloride
  • Baclofen